Healthcare Provider Details

I. General information

NPI: 1609400019
Provider Name (Legal Business Name): ADAM DEPPEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 NORTHWOODS BLVD
VANDALIA OH
45377-9462
US

IV. Provider business mailing address

780 NORTHWOODS BLVD
VANDALIA OH
45377-9462
US

V. Phone/Fax

Practice location:
  • Phone: 937-264-2420
  • Fax: 937-264-2484
Mailing address:
  • Phone: 937-264-2420
  • Fax: 937-264-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03328731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: